Pre-participation sports evaluation — branching viva

Branching framework

Open with the one-sentence framing and the goal of the evaluation. The pre-participation sports evaluation screens a child or adolescent before sport to detect the conditions that threaten life or limb and to promote safe participation, and the fellowship task is to take the AHA 14-element cardiovascular history, to recognise the red-flag items, and to classify the clearance. State the three-part framing — the screen detects the threat, the clearance promotes safe participation, and the emergency action plan protects when the screen misses — before you discuss any single athlete. ^{[1] [3]}

Reproduce the AHA 14-element screen and its 7-3-4 split. The fourteen elements divide into seven personal history items, three family history items, and four physical examination items. The seven personal items are exertional chest pain, unexplained syncope or near-syncope, excessive dyspnea or fatigue with exercise, a prior heart murmur, an elevated blood pressure, a prior restriction from sport, and prior cardiac testing. The three family items are a sudden death before fifty, disability from heart disease in a close relative under fifty, and a known familial cardiomyopathy or channelopathy. The four examination items are the murmur supine and standing, the femoral pulses, the stigmata of Marfan syndrome, and the brachial blood pressure. ^[1]

Branch to the exertional syncope red flag and the first athlete. A blackout during a sprint is exertional syncope, and exertional syncope is sudden cardiac death until proven otherwise. Combined with the paternal uncle's sudden death at forty-one, this athlete has two positive elements and is restricted from sport pending an electrocardiogram, an echocardiogram and a cardiology opinion. State that clearing him as dehydrated and reviewing later is the error that costs the life, because the next exertional event may be the fatal one. ^[3]